Rejuvenating the Periocular Area
Dr Raquel Amado shares her regenerative approach to treating a male patient’s dark circles with Polynucleotides HPT®
Periocular dark circles are a common aesthetic complaint in both men and women. Many people report that they make them look tired and older than their years, which can lead to poor mental wellbeing, while having an impact on their quality of life.1
While dark eye circles are generally considered to affect both sexes equally, research suggests that men usually seek treatment less than women.1 In my experience, this tends to be because they are wary of traditional aesthetic procedures such as botulinum toxin or dermal fillers that they fear may alter their appearance or make them look unnatural. Of course, any ethical and skilled practitioner would ensure this doesn’t happen, but getting these types of patients through the door can be challenging.
That’s why I’ve valued the introduction of regenerative approaches to my treatment portfolio. With both polynucleotides, exosomes and collagen-stimulating fillers, I’m able to address the source of concerns, providing natural results that develop over time and make patients look like the best version of themselves.
This was the case for a 44-year-old male Caucasian patient I recently treated with Polynucleotides HPT®. Here I outline his journey.
Concerns and assessment
My patient presented to clinic complaining about the hollows under his eyes. Upon assessment, I observed that along with the periocular hollowness, his tear troughs appeared dark and the skin was notably thin.
This correlates with typical periocular concerns. One study used multispectral image analysis, ultrasound and video capillaroscopy to determine that the three key physiological factors associated with dark circles in Caucasian patients are hyperpigmentation, a tendency for more dilated, thicker or increased number of capillaries, and thinner skin in the under-eye area.2 It should be noted that there are some variations amongst different ethnicities,2 which should be considered carefully before planning treatment.
Upon taking a medical and lifestyle history, I identified that this patient’s under-eye volume loss had occurred following significant weight loss. This contributed to a loss of facial fat, meaning underlying blood vessels become more visible, darkening the area under the eyes. General ageing had also led to bone loss, infraorbital laxity and wrinkles, which caused shadowing, while some people may naturally experience excessive pigmentation in the area.3 The patient had not regularly used SPF or skincare, which had accelerated the decline in skin quality.
As with all patients, I explained the ageing process to help him understand why he had seen these changes and what options were available to help. I recommended a course of three polynucleotide treatments in combination with NCTF and dermal fillers.
The patient made clear that he did not want dermal filler or botulinum toxin treatment but was open to regenerative approaches.
I then talked to him in more detail about Plinest® – the brand of polynucleotides I use that is created using patented Polynucleotides HPT® technology. After giving the patient time to consider his options, he booked in for his first Plinest® session.
Product choice and treatment protocol
On 26th June, the patient presented to clinic for his first treatment. Before getting started, I reminded him of what he could expect during and after the procedure, giving him the opportunity to ask questions and reconfirm his consent.
I chose to use Plinest® , which comprises 20mg/ml of Polynucleotides HPT®. There is also a specific product for eyes – Plinest® Eye, which consists of 7.5mg/ml. I find this is a great option for patients with minimal periocular concerns or for those who have very delicate skin around their eyes. In this patient, however, I felt that the stronger product would produce a better result. The patient did not have any lymphatic compromise in the area, so I determined it was a safe option. I would, however, discourage practitioners from using the stronger product around the eyes without experience or if they have concerns about managing expectations. Plinest® can take up to a week to be fully absorbed, meaning the patient will have swelling for roughly this amount of time.
The DNA fractions used in Polynucleotides HPT® come from salmon trout that have been bred in fresh waters.
Created by Italian manufacturer Mastelli, the technology is renowned for its stringent purification and sterilisation process that ensures only the safest and most valuable active ingredients are used. It works by promoting a trophic and stimulating action on existing fibroblasts, which increases collagen synthesis and the viability and number of fibroblasts. This translates into having more collagen, elastin and hyaluronic acid. Dermal thickness will increase while inflammation is reduced. Multiple clinical studies have determined it is an effective treatment for fine lines and wrinkles, pigmentation, rosacea, scarring, poor tone and texture and, of course, dark circles.4-6
Prior to treatment, I numbed the skin with topical anaesthetic to minimise discomfort. A cannula was used to inject 0.8ml of Plinest® under the eye before I administered 0.2ml to the lateral canthal lines using a 4mm Sterijet 33G needle. This technique was repeated three weeks later, as per the standard protocol recommendations.
Before and six weeks after two sessions of Plinest®
Results
Upon review on September 7th, the patient was thrilled with the results. There was a clear reduction in dark circles, as well as an improvement in the appearance of fine lines around the eyes.
While I recommended a third treatment to further improve the outcome and increase the longevity of the results, the patient decided against it. Generally, we expect results from Plinest® treatment to last approximately six months.
Introducing Polynucleotides HPT® to my clinic has really changed the way I practice. Being able to offer regenerative approaches as alternatives means I attract a wider demographic, while the benefits of using these treatments in combination with other procedures allow me to boost skin health and optimise results.
References
- Lim HGY, Fischer AH, Sung S, Kang S, Chien AL. Periocular Dark Circles: Correlates of Severity. Ann Dermatol. 2021 Oct;33(5):393-401. doi: 10.5021/ad.2021.33.5.393. Epub 2021 Sep 8. PMID: 34616119; PMCID: PMC8460477.
- Mac-Mary S, Zornoza Solinis I, Predine O, Sainthillier JM, Sladen C, Bell M, O’Mahony M. Identification Of Three Key Factors Contributing To The Aetiology Of Dark Circles By Clinical And Instrumental Assessments Of The Infraorbital Region. Clin Cosmet Investig Dermatol. 2019 Dec 18;12:919-929. doi: 10.2147/CCID.S217956. PMID: 31908515; PMCID: PMC6927230.
- Park KY, Kwon HJ, Youn CS, Seo SJ, Kim MN. Treatments of Infra-Orbital Dark Circles by Various Etiologies. Ann Dermatol. 2018 Oct;30(5):522-528. doi: 10.5021/ad.2018.30.5.522. Epub 2018 Aug 28. PMID: 33911473; PMCID: PMC7992473.
- Cavallini M, Bartoletti E, Maioli L, Massirone A, Pia Palmieri I, Papagni M, Priori M, Trocchi G; As Members of The Polynucleotides HPT™ Priming Board, Collegio Italiano delle Società Scientifiche di Medicina Estetica (Italian College of the Aesthetic Medicine Scientific Societies) - SIME, AGORÀ, SIES. Consensus report on the use of PN-HPT™ (polynucleotides highly purified technology) in aesthetic medicine. J Cosmet Dermatol. 2021 Mar;20(3):922-928. doi: 10.1111/jocd.13679. Epub 2020 Sep 21. PMID: 32799391; PMCID: PMC7984045. https://pubmed.ncbi.nlm.nih.gov/32799391/
- Cavallini M, De Luca C, Prussia G, Raichi M. PN-HPT® (Polynucleotides Highly Purified Technology) in facial middle third rejuvenation. Exploring the potential. J Cosmet Dermatol. 2022 Feb;21(2):615-624. doi: 10.1111/jocd.14578. Epub 2021 Nov 17. Retraction in: J Cosmet Dermatol. 2023 Jul 26;: PMID: 34791770; PMCID: PMC9299481.
- Colangelo MT, Govoni P, Belletti S, Squadrito F, Guizzardi S, Galli C. Polynucleotide biogel enhances tissue repair, matrix deposition and organization. J Biol Regul Homeost Agents. 2021 Jan-Feb;35(1):355-362. doi: 10.23812/20-320-L. PMID: 33480222. https://pubmed.ncbi.nlm.nih.gov/33480222/